"This guide to Stage II recovery is a must read for all, including
survivors ... Drawing on the knowledge gained from her years of experience and from a
practitioner's perspective, Mary Bratton tells what works for survivors of trauma. There
are not enough adjectives to describe what Bratton has captured in this book. She takes a
life-long debilitating disorder and unravels its intricacies in concise, succinct, and
understandable language. She explicitly explains the impact of trauma and the normal
reactions by the victims ... Bratton provides the reader with the key to open and go
beyond the victim's debilitating locked door... Philip A. Whitner, Ph.D. Senior Staff
Counselor University Counseling Center The University of Toledo, Ohio
PREFACE
This is a book about treatment for survivors of childhood abuse,
about helping clients make the critical move from being a victim to being a survivor who
triumphs and thrives. At a deeper level, it is a book about the ingenuity and
indestructibility of the human spirit, about the brilliance of the child victim and the
power of the adult survivor, about the predictable responses to both abuse and healing.
The book is based on the author's firm conviction, developed over years of clinical
practice, that survivors of childhood abuse are profoundly normal and absolutely
extraordinary. They are incredibly resilient and resourceful, not in spite of their
childhood experiences, but because of them. The behavior patterns that are still troubling
them are not evidence of pathology, but proof of the brilliant children they were and the
strong adults they have become.
The entire therapeutic agenda emphasizes what's right rather than what's wrong. The
overriding themes are resolution and empowerment. The question is not: "What's wrong
with me?" The questions are: "How did I get this way?" and "How do I
need to change?"
All the strategies described quickly become self-initiating for the client, encouraging
autonomy and speeding recovery. Offset summaries outline interventions and offer
considerations for treatment planning. Workable and experiential exercises for each stage
of healing facilitate reframing of self-experience, allow completion of interrupted,
frozen trauma, and directly target areas of developmental loss. Exercises are accompanied
by examples of client art and writing. The journaling of one survivor, Jessica, is
interspersed throughout the text, and the progression of her recovery both echoes and
illustrates the therapeutic journey.
CHAPTER 1: THE THERAPEUTIC AGENDA
Childhood abuse is trauma, the pure physical trauma of a life-threatening catastrophe or
the emotional trauma of two conflicting feelings linked together in the same event--love
and pain, love and violence, love and rage. One incident of physical or sexual violation
constitutes abuse; emotional abuse is characterized by a consistent and repeated pattern
of humiliation, sarcasm, ridicule, rejection, or threats. It is often impossible to neatly
categorize the kind of abuse suffered, because physical, emotional, and sexual abuse are
often overlapping. Any kind of childhood abuse violates the child's quest for safety,
second only to food and shelter in Maslow's hierarchy of human needs (Maslow, 1970). The
core of a child's world--the home--is not safe when the very people put on this earth to
protect the child at the worst abuse and at the least fail to defend. Childhood abuse
damages and alters a child's perception of self, others, and the world. Those damaged and
altered perceptions affect each subsequent developmental task.
The Dynamics of Trauma
A traumatic event initiates a two-part process. First, shock mitigates the immediacy of
the catastrophe to allow survival. Then, the built-in drive to heal takes over as the
victim begins processing the trauma, telling the story and spilling the feelings over and
over again until the shock lessens in intensity and the trauma is woven into the fabric of
life. As the sometimes intrusive media reveals on an almost daily basis, processing
happens spontaneously after the danger has passed. However, when processing is blocked by
family denial, by intimidation, by secrecy, and by shame, then the trauma gets frozen in
the shock stage--not finished, not diminished, not integrated. It may loom large in the
conscious landscape or it may be remembered only vaguely, but it continues to dominate the
behavior, the feelings, and the thinking of its victim. It influences relationships,
choices, and beliefs.
Stage II Recovery
By the time the adult survivor reaches therapy, the tentacles of trauma reach deep into
life patterns and self-image. Telling the story is no longer enough to resolve the trauma.
Crazy, dirty, damaged, doomed, different, and defective have become self-defining
adjectives. Coping mechanisms needed only to survive trauma have been over-practiced and
have become self-defeating. Ongoing developmental tasks have been compromised or missed
completely. The distorted reality of the abuser has become truth about self and world.
Treatment must go beyond recounting the story of helplessness and horror replete with the
adult overlays of self-judgment and self-blame. Stage 11 recovery requires the survivor to
achieve closure from the perspectives of both child and adult in order to effect
meaningful transformation in coping strategies, self-view, and world-view.
Eight Stages of Healing
In the context of Stage II recovery, recounting becomes a mid-point in the healing
process. Recounting is based on a paradigm shift in selfexperience from weak to strong and
from crazy to normal, and it is followed by concrete and incremental steps that resolve
the frozen trauma and repair developmental damage in order to complete the mental,
emotional, and spiritual growth interrupted by childhood abuse. Healing is a process that
has a well-defined beginning, a clear direction, and a definite end.
Defining Assault
Healing begins with a one-word intervention. The abuse is redefined as assault. The
legalistic language used to distance society from the brutality of attacks on children
needs to be replaced with the word that speaks reality and truth--assault. The strength of
the word "assault" triggers a sea change that cracks the wall of denial and
minimizing and begins to free the survivor from guilt and blame. Thus begins the journey
from being a victim to being a survivor who triumphs and thrives.
Challenging the Distorted Reality
Implicit in every memory of interrupted trauma is the abuser's interpretation of the
abuse, which almost never includes any admission of adult responsibility. Because the
victim could not process the trauma, there was no exoneration from blame, no chance to
hold the abuser accountable, no independent or rational challenge to the minimizing or the
denial or the gratuitous justification for the abuse. Each distorted belief about the
abuse, about self, and about the world internalized and embedded in the frozen memory
needs to be identified and confronted and dismantled. The web of nationalization and
intellectualization that has excused abusers and collaborators begins to disintegrate.
Using the PTSD Diagnosis as a Therapeutic Intervention
At some secret level most survivors of abuse consider themselves crazy, and many have been
given psychiatric labels that reinforce that belief. They are convinced that they are
somehow dirty, damaged, doomed, different, and defective. As human responses to trauma are
more completely explored and understood, it is becoming clear that the therapeutic
community, with the best of intentions, has been capable of pathologizing and
re-traumatizing survivors with fragmented diagnoses that identify only one aspect of
trauma response and fragmented treatments that address only superficial symptoms of trauma
survival. It is a disservice to tell survivors that they are anything less than normal
given their histories. Post-traumatic Stress Disorder is the one diagnosis that says, in
effect: "You are having a normal reaction; what happened to you was abnormal. "
To leap from symptoms of trauma to content of trauma is both dangerous and irrational, yet
it is something both client and therapist are sometimes tempted to do. The phenomenon of
traumatic memory repression and the ensuing swirl of controversy and advocacy around false
memory have fueled the confusion between event and effect. The symptoms of PTSD suggest
that something catastrophic happened. They do not precisely define what that catastrophe
was. They certainly do not determine that it was sexual abuse. Although it is wonderful
that the wall of silence around child sexual abuse has finally been shattered, the
resulting media and self-help preoccupation diminishes the very real agony of survivors of
physical violence and emotional assault.
There is no single trauma and there is no single level of trauma that has to happen before
PTSD symptoms can occur. Sometimes an event that is traumatic to one person is not so
devastating to another, given differences in surrounding circumstances and support. A
competent therapist does not make the search for new memories the sole or even primary
goal of therapy. If new memories surface, they must be evaluated from psychosocial,
cognitive, perceptual, conceptual, and social learning developmental perspectives by a
therapist familiar with Erikson (1963), Piaget (1952, 1954, 1967), Bandura (1977), and
their disciples. The therapist's job is to guide the client to use existing memories to
understand behavior patterns within the context of PTSD, not to force the client to search
out new memories to explain or justify symptoms.
Historically, the PTSD diagnosis was formulated to describe adult responses to trauma in
war. The diagnostic criteria for PTSD in DSM-IV do not fully allow for the range of
symptoms exhibited by survivors of hostage situations, which is a child's experience in an
abusive family. Nor do the diagnostic criteria fully reflect the range of symptoms that
stem from trauma that occurs during the critical developmental stages of childhood
(American Psychiatric Association, 1994). Nevertheless, until the PTSD diagnostic criteria
are expanded to include additional symptoms like those proposed for Complex PTSD (Herman,
1992), the PTSD diagnosis and all it implies about normal responses to abnormal events
remains the best and most accurate intervention available.
The therapist's knowledge of the neurophysiology and psychology of trauma needs to be more
than superficial to adequately answer all the survivor's questions and doubts and to
meaningfully reframe the survivor's interpretation of symptoms. The PTSD diagnosis itself
catalyzes the shift in self-experience from crazy to normal and augments the shift from
dirty, damaged, doomed, defective, and different to blameless.
Understanding the Brilliance of Childhood Defenses
Defenses formed in moments of childhood trauma are deeply and stubbornly rooted and
resistant to change. They are connected to survival at a primal level. They have been
overused to the point of excluding the acquisition of more productive and appropriate
coping skills. The repetition of what have become self-defeating patterns contributes to
the survivor's sense of being crazy, dirty, damaged, doomed, different, and defective.
Survivors need to understand their defenses are normal, not just because they are typical
patterns shared with other survivors. They are normal in the light of what is known about
human responses and behavior. And they are brilliant because they represent creative and
sophisticated uses of human coping mechanisms. Redefining so-called crazy coping skills as
brilliant responses to the chaos and confusion of an abusive childhood changes
self-definition from weak victim to strong survivor. This gives the client the final
building block for the paradigm shift in self-concept that underpins healthy recounting.
Recounting
Not until a significant alteration in self-view has occurred is the survivor ready to tell
the story of trauma. Forced or premature recounting has potential for reinforcing guilt
and shame as the survivor once again confesses misdeeds and character defects in a story
contaminated with all the altered reality of the abuser and the dysfunctional family. Some
survivors need to be actively discouraged from detailed recounting early in therapy, in
order to avoid further locking in the distorted version.
Recounting is neither the beginning nor the end of healing. It is simply part of the
process. Healthy recounting encourages survivors to examine their histories in order to
understand what they learned, not to blame. Recounting does not just answer the question:
"What happened?" It answers the more important questions: "How did I get
this way?" and "How do I need to change?" Only when the story can be told
from a base of reality, with understanding, power, and control, can it become the
foundation for transformative Stage 11 recovery.
Reparenting To Resolve Trauma
Years of denial and layers of minimizing and guilt and shame overlay every abusive
episode. Often memories are interrupted abruptly by dissociation that preempts storage and
retrieval. Memories are devoid of rescue or resolution. To return to the frozen memory
means to return to that moment of never-ending terror and impending death. Because the
memory is frozen, the abuse has never stopped at some level of the psyche. Resolution
fantasy creates an imaginary ending that allows that frozen part of self to grow up,
through and past the moment of attack, and to complete the trauma using the needs and
feelings of the child and the strength and capabilities of the adult.
Just as emotional and physical and sexual abuse are often overlapping, healing is also
overlapping. Each traumatic incident does not need to be resolved individually. Rather,
working through one abusive incident with resolution fantasy produces a cascade of healing
that applies across the board, so that lasting recovery from years of trauma can be
accomplished rapidly.
Repairing Developmental Damage
Recounting increases understanding of the crucible in which defenses were formed.
Resolution of the traumatic memories frees the survivor from the tyranny of defenses
necessary for suppression and survival. The door is open for elimination and alteration of
behaviors that are counterproductive to healthy adulthood. Even survivors who got help as
children may need to integrate the meaning of the abuse into later developmental
imperatives and adjust coping skills acquired after the abuse but still based on
inadequate understanding of its impact.
Recovery does not require a total change in being. All the tools needed to heal are
already present in the victim's feelings and the survivor's tenacity. Skill gaps can be
identified and filled. Defenses relevant only to surviving abuse can be gently
relinquished from a position of strength and gratitude. Already brilliant survival skills
can be modified so they more aptly fit adult needs.
Grief is an integral part of all work with survivors, and it is dominant during this
period of letting go. Recovery requires survivors to accept responsibility for the people
they are and the people they choose to become. Having a horrible childhood is not an
excuse for being miserable as an adult.
Integration and Transformation
The final stage of healing occurs as the survivor accommodates to history. Although
individual memories of trauma can be unfrozen and completed, the abuse is a fact of
existence that cannot be changed. Accepting responses that will be normal given that
history, recognizing that the abuse is a part but not the whole of formative influences
and experiences, and letting go of the survivor identity that has driven and propelled
healing allow the client to move beyond surviving to thriving and to claim a sense of
wholeness and well-being that is the hallmark of Stage II recovery.
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